Adams O Peter, Carter Anne O
Faculty of Medical Sciences, The University of the West Indies, Cave Hill Campus, St, Michael, Barbados.
BMC Res Notes. 2010 Nov 22;3:316. doi: 10.1186/1756-0500-3-316.
About 55% of the population 40 to 80 years of age in Barbados is hypertensive. The quality of hypertension primary care compared to available practice guidelines is uncertain.
Charts of hypertensive and diabetic patients were randomly sampled at all public and 20 private sector primary care clinics. Charts of all hypertensive patients ≥ 40 years of age were then selected and processes of care and blood pressure (BP) maintenance < 140/90 documented.343 charts of hypertensive patients (170 public, and 173 private) were audited. Patients had the following characteristics: mean age 64 years, female gender 63%, mean duration of diagnosis 9.1 years, and diabetes diagnosed 58%. Patients had an average of 4.7 clinic visits per year, 70% were prescribed a thiazide diuretic, 42% a calcium channel blocker, 40% an angiotensin receptor blocker, and 19% a beta blocker. Public patients compared to private patients were more likely to be female (73% vs. 52%, p < 0.01); have a longer duration of diagnosis (11.7 vs. 6.5 years, p < 0.01), and more clinic visits per year (5.0 vs. 4.5, p < 0.01). Over a 2 year period, the proportion of charts with the following recorded at least once was: BP 98%, weight 80%, total cholesterol 71%, urine tested for albumin 67%, serum creatinine 59%, dietary advice 55%, lipid profile 48%, exercise advice 45%, fasting blood glucose for non-diabetics 39%, dietician referral 21%, tobacco advice 17%, retinal examination 16%, body mass index 1%, and waist circumference 0%. Public patients were more likely to have recorded: weight (92% vs. 68%, p = < 0.01); tests for total cholesterol (77% vs. 67%, p = 0.04), albuminuria (77% vs. 58%, p = < 0.01), serum creatinine (75% vs. 43%, p < 0.01), and fasting blood glucose for non-diabetics (49% vs. 30%, p = 0.02); dietician referral (34% vs. 9%, p < 0.01), and tobacco advice (24% vs. 10%, p < 0.01). Most (92%) diastolic BP readings ended in 0 or 5 (72% ended in 0). At the last visit 36% of patients had a BP < 140/90 mmHg.
Improvements are needed in following guidelines for basic interventions such as body mass assessment, accurate BP measurement, use of thiazide diuretics and lifestyle advice. BP control is inadequate.
在巴巴多斯，40至80岁的人群中约55%患有高血压。与现有实践指南相比，高血压初级护理的质量尚不确定。
在所有公立和20家私立初级护理诊所随机抽取高血压和糖尿病患者的病历。然后选取所有年龄≥40岁的高血压患者病历，并记录护理过程和血压维持情况<140/90。对343份高血压患者病历（170份公立和173份私立）进行了审核。患者具有以下特征：平均年龄64岁，女性占63%，平均诊断时长9.1年，58%的患者被诊断出患有糖尿病。患者每年平均就诊4.7次，70%的患者被开了噻嗪类利尿剂，42%的患者被开了钙通道阻滞剂，40%的患者被开了血管紧张素受体阻滞剂，19%的患者被开了β受体阻滞剂。与私立患者相比，公立患者更可能为女性（73%对52%，p<0.01）；诊断时长更长（11.7年对6.5年，p<0.01），且每年就诊次数更多（5.0次对4.5次，p<0.01）。在两年期间，至少有一次记录以下内容的病历比例为：血压98%，体重80%，总胆固醇71%，尿白蛋白检测67%，血清肌酐59%，饮食建议55%，血脂谱48%，运动建议45%，非糖尿病患者空腹血糖39%，营养师转诊21%，烟草建议17%，视网膜检查16%，体重指数1%，腰围0%。公立患者更可能有以下记录：体重（92%对68%，p=<0.01）；总胆固醇检测（77%对67%，p=0.04），蛋白尿（77%对58%，p=<0.01），血清肌酐（75%对43%，p<0.01），非糖尿病患者空腹血糖（49%对30%，p=0.02）；营养师转诊（34%对9%，p<0.01），以及烟草建议（24%对10%，p<0.01）。大多数（92%）舒张压读数以0或5结尾（72%以0结尾）。在最后一次就诊时，36%的患者血压<140/90 mmHg。
在遵循基本干预指南方面需要改进，如体重评估、准确的血压测量、噻嗪类利尿剂的使用和生活方式建议。血压控制不足。
